Sleep quality, short-term and long-term CPAP adherence

Abstract

Study objectives: Adherence to CPAP therapy is low in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). The purpose of the present study was to evaluate the utility of measures of sleep architecture and sleep continuity on the CPAP titration study as predictors of both short- and long-term CPAP adherence.

Methods: 93 patients with OSAHS (RDI 42.8 ± 34.3/h) underwent in-laboratory diagnostic polysomnography, CPAP titration, and follow-up polysomnography (NPSG) on CPAP. Adherence to CPAP was objectively monitored. Short-term (ST) CPAP adherence was averaged over 14 days immediately following the titration study. Long-term (LT) CPAP adherence was obtained in 56/93 patients after approximately 2 months of CPAP use. Patients were grouped into CPAP adherence groups for ST (< 2 h, 2-4 h, and > 4 h) and LT adherence (< 4 h, > 4 h). Sleep architecture, sleep disordered breathing (SDB) indices, and daytime outcome variables from the diagnostic and titration NPSGs were compared between CPAP adherence groups.

Results: There was a significant relationship between ST and LT CPAP adherence (r = 0.81, p < 0.001). Neither ST nor LT adherence were related to demographic variables, baseline severity of untreated SDB, sleep architecture, or measures of daytime impairment. Good CPAP adherence groups had significantly lower %N2 and greater %REM on the titration NPSG. A model combining change in sleep efficiency and change in sleep continuity between the diagnostic and titration NPSGs predicted 17% of the variance in LT adherence (p = 0.006).

Conclusions: These findings demonstrate that characteristics of sleep architecture, even on the titration NPSG, may predict some of the variance in CPAP adherence. Better sleep quality on the titration night was related to better CPAP adherence, suggesting that interventions to improve sleep on/prior to the CPAP titration study might be used as a therapeutic intervention to improve CPAP adherence.

Keywords: CPAP adherence; CPAP therapy; OSAHS treatment; obstructive sleep apnea; sleep disordered breathing; sleep stages.

Figures

Figure 1. Flow chart of study protocol

Figure 2

Graph plots data of pressure deviation from therapeutic pressure on the x-axis versus CPAP use (h) at that pressure in patients who were subjected to multiple pressures (± 2-3 cm H2O above or below) during the short-term adherence period. No relationship was seen between adherence and pressure (r = 0.07, p = ns).

Figure 3

Number of patients grouped by CPAP adherence is shown for (A) short-term (n = 93) and (B) long-term (n = 56) data.

Figure 4

Graph shows short-term CPAP adherence (x-axis) plotted against long-term adherence (y-axis) (r = 0.81, p

Figure 5

(A) The graph shows the ST adherence grouped by subject responses to the question “How would you rate your sleep after using CPAP?” the morning after the titration study. No significant differences were seen between groups. (B) The graph shows the ST adherence grouped by subject responses to the question “How would you rate your CPAP treatment?” the morning after the titration study. No significant differences were seen between groups. (C) The graph shows the ST adherence grouped by subject responses to the question “Would you like to continue to use CPAP therapy at home?” The group that answered “yes” had a significantly (p < 0.001) higher CPAP adherence that the group who answered “No/Not Sure.” The graphs shows the mean and SD of ST CPAP adherence in each group.